Electronic alerts for ambulatory patients with atrial fibrillation not prescribed anticoagulation : A randomized, controlled trial (AF-ALERT2)
Copyright © 2023 The Authors. Published by Elsevier Ltd.. All rights reserved..
BACKGROUND: Despite widely available risk stratification tools, safe and effective anticoagulants, and guideline recommendations, anticoagulation for stroke prevention in atrial fibrillation (AF) is under-prescribed in ambulatory patients. To assess the impact of alert-based computerized decision support (CDS) on anticoagulation prescription in ambulatory patients with AF and high-risk for stroke, we conducted this randomized controlled trial.
METHODS: Patients with AF and CHA2DS2-VASc score ≥ 2 who were not prescribed anticoagulation and had a clinic visit at Brigham and Women's Hospital were enrolled. Patients were randomly allocated, according to Attending Physician of record, to intervention (alert-based CDS) versus control (no notification). The primary efficacy outcome was the frequency of anticoagulant prescription.
RESULTS: The CDS tool assigned 395 and 403 patients to the alert and control groups, respectively. Alert patients were more likely to be prescribed anticoagulation within 48 h of the clinic visit (15.4 % vs. 7.7 %, p < 0.001) and at 90 days (17.2 % vs. 9.9 %, p < 0.01). Direct oral anticoagulants were the predominantly prescribed form of anticoagulation. No significant differences were observed in stroke, TIA, or systemic embolic events (0 % vs. 0.8 %, p = 0.09), symptomatic VTE (0.5 % vs. 1 %, p = 0.43), all-cause mortality (2 % vs. 0.7 %, p = 0.12), or major adverse cardiovascular events (2.8 % vs. 2.5 %, p = 0.79) at 90 days.
CONCLUSIONS: An alert-based CDS strategy increased a primary efficacy outcome of anticoagulation in clinic patients with AF and high-risk for stroke who were not receiving anticoagulation at the time of the office visit. The study was likely underpowered to assess an impact on clinical outcomes.
TRIAL REGISTRATION: ClinicalTrials.gov Identifier- NCT02958943.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2023 |
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| Erschienen: |
2023 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:227 |
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| Enthalten in: |
Thrombosis research - 227(2023) vom: 01. Juli, Seite 1-7 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Piazza, Gregory [VerfasserIn] |
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| Links: |
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| Themen: |
Anticoagulants |
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| Anmerkungen: |
Date Completed 05.06.2023 Date Revised 21.06.2023 published: Print-Electronic ClinicalTrials.gov: NCT02958943 Citation Status MEDLINE |
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| doi: |
10.1016/j.thromres.2023.05.006 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM356850625 |
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| 100 | 1 | |a Piazza, Gregory |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Electronic alerts for ambulatory patients with atrial fibrillation not prescribed anticoagulation |b A randomized, controlled trial (AF-ALERT2) |
| 264 | 1 | |c 2023 | |
| 336 | |a Text |b txt |2 rdacontent | ||
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| 500 | |a Date Completed 05.06.2023 | ||
| 500 | |a Date Revised 21.06.2023 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a ClinicalTrials.gov: NCT02958943 | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a Copyright © 2023 The Authors. Published by Elsevier Ltd.. All rights reserved. | ||
| 520 | |a BACKGROUND: Despite widely available risk stratification tools, safe and effective anticoagulants, and guideline recommendations, anticoagulation for stroke prevention in atrial fibrillation (AF) is under-prescribed in ambulatory patients. To assess the impact of alert-based computerized decision support (CDS) on anticoagulation prescription in ambulatory patients with AF and high-risk for stroke, we conducted this randomized controlled trial | ||
| 520 | |a METHODS: Patients with AF and CHA2DS2-VASc score ≥ 2 who were not prescribed anticoagulation and had a clinic visit at Brigham and Women's Hospital were enrolled. Patients were randomly allocated, according to Attending Physician of record, to intervention (alert-based CDS) versus control (no notification). The primary efficacy outcome was the frequency of anticoagulant prescription | ||
| 520 | |a RESULTS: The CDS tool assigned 395 and 403 patients to the alert and control groups, respectively. Alert patients were more likely to be prescribed anticoagulation within 48 h of the clinic visit (15.4 % vs. 7.7 %, p < 0.001) and at 90 days (17.2 % vs. 9.9 %, p < 0.01). Direct oral anticoagulants were the predominantly prescribed form of anticoagulation. No significant differences were observed in stroke, TIA, or systemic embolic events (0 % vs. 0.8 %, p = 0.09), symptomatic VTE (0.5 % vs. 1 %, p = 0.43), all-cause mortality (2 % vs. 0.7 %, p = 0.12), or major adverse cardiovascular events (2.8 % vs. 2.5 %, p = 0.79) at 90 days | ||
| 520 | |a CONCLUSIONS: An alert-based CDS strategy increased a primary efficacy outcome of anticoagulation in clinic patients with AF and high-risk for stroke who were not receiving anticoagulation at the time of the office visit. The study was likely underpowered to assess an impact on clinical outcomes | ||
| 520 | |a TRIAL REGISTRATION: ClinicalTrials.gov Identifier- NCT02958943 | ||
| 650 | 4 | |a Randomized Controlled Trial | |
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Anticoagulation | |
| 650 | 4 | |a Antithrombotic therapy | |
| 650 | 4 | |a Atrial fibrillation | |
| 650 | 4 | |a Computerized decision support | |
| 650 | 4 | |a Electronic alerts | |
| 650 | 4 | |a Stroke | |
| 650 | 7 | |a Anticoagulants |2 NLM | |
| 700 | 1 | |a Hurwitz, Shelley |e verfasserin |4 aut | |
| 700 | 1 | |a Campia, Umberto |e verfasserin |4 aut | |
| 700 | 1 | |a Bikdeli, Behnood |e verfasserin |4 aut | |
| 700 | 1 | |a Lou, Junyang |e verfasserin |4 aut | |
| 700 | 1 | |a Khairani, Candrika D |e verfasserin |4 aut | |
| 700 | 1 | |a Bejjani, Antoine |e verfasserin |4 aut | |
| 700 | 1 | |a Snyder, Julia E |e verfasserin |4 aut | |
| 700 | 1 | |a Pfeferman, Mariana |e verfasserin |4 aut | |
| 700 | 1 | |a Barns, Briana |e verfasserin |4 aut | |
| 700 | 1 | |a Rizzo, Samantha |e verfasserin |4 aut | |
| 700 | 1 | |a Glezer, Alexandra |e verfasserin |4 aut | |
| 700 | 1 | |a Goldhaber, Samuel Z |e verfasserin |4 aut | |
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